The editorial continues to say that hospital delivery should be the preferred method of delivery for high-risk pregnancies and wrote that the desires of the mother and the health of the children “are competing interests that need to be weighed carefully.”

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twoathome

crap propagated by the medical establishment. fully trained midwives are just as qualified as drs at resucistation. No self respecting professional will do anything but a normal risk pregnancy at home. Remember, the medical establishment is a business. The way they deal with unwanted competition is through self serving "studies" and scare tactics.

I suppose midwifery is not a business? So since >99% of the business has chosen to deliver in a hospital setting it would seem that the "home birth industry" has even more incentive to use "scare tactics" and "self serving studies" and appeal to one's sense of what is "natural" (and imply that it is therefore better) in order to gain a little market share.....certainly the "medical establishment" isn't that highly motivated to prevent "unwanted competition" since that competition is relatively small. Maybe the other way around....just a thought.

This is propaganda set up by a patriarchal medical establishment. Maternal deaths skyrocketed due to infection when male doctors muscled midwives out of a woman's natural sphere. Midwives were trained to handle emergencies as well as let nature take its course in a supportive, less stressful environment. Women had been doing this since time immemorial, often giving birth on their own after taking a shot of whiskey. During my great grandmothers time, few women could afford hospital births and they did fine. How is it rural women in the 1880s had, like, 10 kids? The infant mortality that is harped on is from diseases contracted after birth, such as smallpox, polio, typhoid, and the like, when vaccinations did not exist and penicillin was unheard of. Kids are stillborn in hospitals even today and mothers die or lose limbs from hospital related infections and disease. Just because drs. take control of a natural process does not mean risk goes down. Childbirth has always been dangerous.

Ihh
Seems that you assume that the complications had to do with "male doctors". Actually, the germ theory didn't exist when midwives were practicing either. This wasn't about "males" vs. "females" in a "woman's ?natural? sphere" ... it was about the advent of a hospital (seems like Florence Nightingale was a female who advocated to put the sick together...) setting where economies of scale could make caring for medical conditions easier. So when ONE provider (male or female, usually midwife for delivery, sometimes a "male doctor") rendered care to multiple patients, and didn't know about the germ theory (because a PERSON (male or female)) hadn't identified bacteria yet, went from one laboring patient to the next, they didn't realize they were spreading germs. Kinda like we didn't know that AIDS existed or how it was spread until relatively recently. But medical science (which it seems that many hold in contempt) has since discovered how to prevent this and saved countless lives. By the way, we now know that a "shot of whiskey" really isn't as safe as other medications when patients need them. And, in your grandmother's time, those who had 10 kids had been lucky enough to continue to carry children....those not so lucky died during childbirth along with their child and often were not included in "statistics" since there was no formal "medical establishment" to record them (as is the case with many of the 3rd world countries to which we compare ourselves to today). Natural selection resulted in survival of the fittest....x-ray studies of cadavers who died during childbirth often show smaller pelvis in these unfortunate women. Today, they survive and pass along the gene for small pelvis or larger babies, etc. Preterm deliveries were often not counted as "liveborn" either. I agree that "just because Drs. take control of a natural process does not mean that risk goes down" but I don't think that is the case here. "Childbirth has always been dangerous" and homebirth does not decrease this danger (although admittedly attended homebirth is MUCH safer) but ATTENDED HOSPITAL BIRTH CERTAINLY DOES by allowing for rapid and early intervention. I don't think that "less maternal interventions" is a benefit when weighed with "less neonatal death" (and presumably less neonatal morbidity ... since many more likely survive with harm rather than die at birth.

I am sorry that you live in such a horrible world. I imagine that with a lot of patience and understanding you can move to the "real world". There is ZERO competetion between the horrific hospital birth and a wonderful home birth. (Please understand that a very very small percentage of pregnancies are not candidates for home birth). You remind me of the poster above who incorrectly assumes that "education" can only come from medical doctors. For shame, these are the same folks that thought Thalidomide was "helpful", or that removing the appendix was "the right thing to do if you had intestinal pain", and most recently the AMA (under the D'oh, no sh!t" clause decided that mother nature MIGHT be right and has condoned breastfeeding (wow, millions of years of history can't be wrong).

Until Americans accept that "research" includes both anecdotal and empirical data from reliable resources, we are stuck. CNN reports that unattended home births are worse off than dumb ass MD attended hospital births? Can we not get apples for apples comparisons? How about "how many kids dod MDs kill past year" vs "how many midwives f'ed up worse than an entire hospital unit"?

kevin, reexamine where the "vitrol" comes from with the understanding that scare tactics and pandering to your "what if" fear is quite vitriolic in its own right. hospitals are for people who are ill. Normal childbirth isn't an illness, although having a child in a hospital increases your chances of contracting an illness through infection. BOO.

My husband and I weighed all of our birthing options in anticipation of the birth of our first child. Many of my friends had made the decision to utilize midwives. I had a wonderful and healthy pregnancy but we made the decision to deliver in a hospital to protect our child from any unforeseen emergencies that could arise during delivery. I delivered our daughter without the aid of drugs. (The doctor never pressured me to use drugs or have a c-section.) However, after the delivery of the placenta, the doctor discovered that my placenta had adhered to my uterus and I was rushed into surgery. I would have certainly died if I had chosen a homebirth. My situation was unforeseeable. It took the hospital less than five minutes to recognize my emergency, prep me for surgery, and whisk me away to the operating room. I will not conjecture as to why more individuals are making the choice to give birth in the home but I encourage individuals to seriously weigh the risks that could occur to both themselves and their child before making such a decision.

I have to laugh at the idea that OBs are in it for the money–try finding a high-risk OB in your area, and see just how few there are anymore. Malpractice insurance for OBs is insane!

While I can appreciate the desire to have a home birth for many reasons, I will never choose to do so. There are too many conditions and complications that are not predictable. Just one example: My own daughter was born with a congenital diaphragmatic hernia (occurs in approximately 1 in 2500 births), a congenital defect that is fatal in roughly half of all cases, and it is NOT always detected by ultrasound. What often is a deciding factor for survival in this particular case is how quickly the baby is intubated and stabilized in a NICU. It's bad enough if you're in a hospital and this condition was missed at first–I shudder to think of being far from medical help at all. Even knowing she had this condition, when I was in labor I was not pressured to have drugs or a c-section and only agreed to a c-section when we saw signs of fetal distress.

Are hospitals ideal? No. But they're getting better because of patients' concerns. Shop around, find the doctor who's most willing to follow your birth plan and not a bully-type. When you're pregnant, you have the time to make those choices. When you're in labor and a crisis occurs, you're stuck with what you have.

Did you ever consider that your child developed with this defect and was not meant to live? As a pregnant woman I know this is a terrifying thought... but not every child develops properly, and as a society we are only weakening the gene pool by actually assisting in furthering the life of abnormally developing babies. I am planning a home birth, and I am trusting nature and mine and my spouses healthy genes to bring me a healthy, happy baby; One whom will only contribute to our collective gene pool, rather than detract from it.

I find it funny that it states: Moms have a right to “choose how and where to give birth,” says an editorial from the medical journal Lancet, “but they do not have the right to put their baby at risk.” But, abortion is legal? Ok.

I had my first child in a hospital setting. It is much more stressful. People constantly coming in and out, checking blood pressure, asking questions...I just wanted to be left alone. If I needed someone, I would call. There are so many interventions and interventions for the interventions. No eating anything, just in case a C/S is needed, and be happy they give you ice chips. There is also the rule that if a mom has not delivered within 12 hours, it would be a mandatory C/S for "failure to progress". The next rule is that I had to push in the prone position with my legs in the air...which was hell, really. While I had been induced with Pitocin, I managed to still have a natural, drug-free birth...but it was definitely hard and I felt exhausted after the ordeal (and not due to the birth, but the constant interruptions).

My next 2 births were homebirths. The difference in them was astounding. I had full control of the lights, the temperature, whether or not I wanted to shower or get in the tub...walk around. I was allowed to do whatever I needed. Hungry? Eat. Thirsty? Drink. Lie down, stand up, squat, rock on all fours or sit on the floor and meditate. Whatever I wanted to do, I had the freedom to do. I had a homebirth doctor for my 2nd child and my 3rd child was attended by a midwife.

I am pregnant with twins now and will do whatever I can to make sure that I am not "suckered" into a c-section. Breech, I can do that. So, it may be harder...probably be easier than trying to recover from major surgery (C/S) with 2 newborns, and 3 older children. If I have to have a C/S, I most certainly will. But, I will not be forced into one because the modern day doctors have all but forgotten the real "tricks" to birth.

And, BTW...all of my babies were fine. My homebirth doctor practiced homebirth for 30 years. My midwife for 25. You don't just pick someone off the street and ask them to delivery your baby for you with no experience.

I cannot believe a lot of the totally uneducated comments on this board. The US has the highest rate of maternal and infant death in just about all of the developed nations and the nations that have the best ratios??? Are the ones where healthy pregnant moms use midwives at home and high risk moms use doctors at hospitals. I believe that is how it should be.

My first was born in a hospital, I was a relatively low-risk first time mom. Everything the hospital did made things more risky, more damaging. Things went relatively smoothly because I knew enough to say "no" to unnecessary interventions, but the second stage was still significantly mismanaged and the resulting tear cause permanent dysfunction.

My second was born at home. We were both technically high risk, but at home, I had a simple waterbirth, my baby was not traumatized, I birthed vaginally with no tearing because I was able to completely relax in the water to let my pelvis release enough to birth a baby with a 14 inch head that did not mold at all. Breastfeeding was difficult but ultimately successful, and my daughter's progress with her very rare chromosome issue (undiagnosed before birth) has been much better than her hospital-born peers with the same syndrome. In the hospital, I can say with 100% certainty that she would have been born via cesarean, at great risk to me (I have a clotting condition,) to her (she was already uncoordinated enough that one more thing interfering with establishing normal breathing could have been catastrophic), and she would have been in the NICU for feeding issues rather than being managed at home, and it would have made breastfeeding much more difficult.

As it was, her birth was painful and difficult, and the postpartum was very rough, but we both came through it as well as could be expected under the circumstances. I've been at enough hospital births (15+) to know how much worse it could have been in a medical environment. I sat down with my midwife and we went over every risk factor, and in not one single case was there a compelling medical advantage to going the hospital route in our situation. I might have felt differently if I didn't live within 10 minutes of a facility capable of handling a high risk emergency birth, but given that I knew I'd be willing to go in if something went wrong? We were safer starting out at home. Ultimately it was my choice as to which risks and consequences I was willing to live with. I was not willing to go along with a schedule of routine anticoagulation and induction at 39 weeks. Given that my daughter was born at 41+ weeks acting like a baby of much younger gestation, this was 100% the right call. She was born, I kept her on my body for her first six weeks, kangaroo-care style, we watched her weight closely and used alternative feeding methods when necessary, and she has thrived as much as it is possible for a child with her condition to thrive.

When it comes down to it, parents are ultimately the ones who have to live with the consequences of the choices they make during pregnancy and birth and postpartum. Not doctors, not nurses, not the Lancet. For parents who choose to look at the entire picture and make a choice which may seem counter to "standard practice," ultimately they, and only they will be the ones who live with the livelong repercussions of that choice, positive or negative. I chose to birth at home. And I know that my daughter's problems do NOT stem from medical malpractice, but from the random chance that took away a little bit of one of her chromosomes. She has never been hospitalized overnight in her life, despite a condition which we were told after her birth might have a mortality rate as high as 70%. I'm the one who chose not to have prenatal testing for genetics (I was 32 when I got pregnant, there was no strong indicator that this would be relevant, and I knew I wouldn't abort regardless.) And I'm the one who lives with the consequences of that choice, for better or worse. Not a doctor, not a hospital, and not a magazine. Until the doctors and hospitals and magazines are ready to step in and stay up all night to nurse, pump and bottlefeed a baby with no suck, until they're ready to take over when I'm dealing with severe postpartum trauma due to having my wishes and decisions for birth ignored completely and unnecessarily, then those decisions don't get to rest with the medical establishment.

It's my body, my baby and my life. And I will do the best I humanly know how to do for my children. That includes both planning for homebirth, and being flexible enough to change plans if the circumstances warrant it.

I've been at births where a homebirth was planned and ultimately the decision was made to go to the hospital and have a c-section. I am glad the option exists where needed. But it's not something to force on rational adults capable of making their own decisions.

Some people are comfortable accepting the risks of jumping out of airplanes. I'm not, but I'm not going to force that choice on them. Some people are comfortable letting their children use trampolines. I'm not, but I'm not going to try to take away all the trampolines.

A very wise midwife once said, "Birth is as safe as life gets." The secret? Life isn't actually all that safe to begin with. There are no guarantees, and the hospital can't guarantee a healthy pregnancy and birth any more than a car dealer can guarantee you will never crash. I had a doctor once lecture me on the safety of giving birth at home... and I miscarried the next day. And the hospital could do nothing to fix it. Life is like that. I'd rather take what some would consider a risk, knowing the potential benefit is great, than pretend that there is no risk doing things the way others would prefer to have me do them.

It is quite disappointing that such junk science would sprout legs and walk around the news media. The only thing that Wax, et. al. did was to breath new life into old flawed studies that have been widely criticized on their technical merit. If you want to study outcomes of planned home birth, it is imperative that you be able to differentiate between 1) planned home birth that is attended by a trained midwife, 2) planned but unattended home birth and 3) unplanned and unattended home birth. If you do nothing else, you must assure quality control over this as these attributes are key in understanding outcomes. The studies that Wax, et. al. selected to base their conclusions on neonatal mortality rates (conclusions that were established a priori) could not make the distinction (even though the Wax, et. al. clearly tried to hide which studies were used in estimating neonatal mortality rates).

Here are more than a few criticisms of this paper in the National Childbirth Trust's critique of Wax Paper:

http://www.nct.org.uk/about-us/what-we-do/policy/choiceofplaceofbirth

I am now going to play the integrity card. It is clear that the authors new exactly what they were doing in light of legislative initiatives seeking to expand access to home birth midwives along with accelerating rates of planned home birth. Their technical records should be audited and this study should be withdrawn from publication except for how this illustrates how bias, and entrenched opposition, can influence the development of scientific literature.

I respect women who choose to give birth at home, but things can go wrong...
I was in perfect health, with an uneventful pregnancy, with my first baby. I chose to deliver in a hospital just in case anything went wrong. Turns out they had to monitor the baby because of fetal distress (he turned out to have the cord wrapped around himself twice); luckily, he was fine when he was born. About 2 hours after I delivered, I was eating breakfast when the room started spinning. I passed out and didn't wake up for several hours. I had hemmoraged severly and could have died. Home delivery professionals (hopefully) could have dealt with this, but nonetheless, I was happy to be where all the health care resources were right there for me. It's important for moms to have full resources in a health care setting, as well as babies.

desubluxator, I had two WONDERFUL Hospital births, and I have not attacked the home birthers. It is a woman's choice where and how she wants to have a baby. I chose a hospital birth for both babies. The first time I had a midwife, an epidural. The second time I had an ob/gyn, epidural, induction (due to medical issues that necessitated birth). NEITHER births were an 'abomination'. They were the most beautiful, happy, wonderful days of my life, and I am NOT going to blast a woman for wanting to have that day at her home. HOWEVER, I DO take offense to you insinuating that just because I gave birth in a hospital that my births were horrible abominations.

I had a homebirth back in July 09. I feel that is where low risk pregnancies, labors, and births belong. Hospitals are great for those who are in need of medical attention during pregnancy or otherwise. This little summary is just silly and misleading. Hospital births *can* be harmful just like anything *can* be anything. Read up on the risks of pitocin, epidurals, C-sections, along with the rates and you will find that home birth attended by a certified midwife is much safer than at the hospital.

After reading a large handful of comments I had some things to add to my earlier comment.

1) When did personal responsibility become non existent? Whether using a midwife or doctor everyone should know about their care givers. Ask questions, see credentials, seek out some previous patients to find out who your care giver is and if they are right for you.

2) Do you(general you) think that midwives don't do any prenatal care and assess risks? They do just as much as OBs do in their offices. Many MWs now even order at least 1 ultrasound to verify the health of the fetus and do many of the modern testing that is done in medical facilities. They aren't doing all of this perceived "dirty hippie" stuff. They are using time tested methods of care in combination with modern. The difference is, they know when enough is enough. Again, knowing your midwife and her credentials is essential, but to me that seems obvious about any care giver.

3)Hospital births are often over medicated. How many hospital births have lead to complications, surgeries, and deaths that would have never happened had the birth been at home, or at the very least left alone? Something we can never know but the U.S. infant mortality rate in combination with the induction and cesarean rates speak volumes.

I forgot to add to number two as well, MWs take low risk moms and strongly practice preventative care through diet recommendations, herbal teas, and in depth pre and post-natal care. OBs do not focus so much on preventative care but rather just "treat" whatever problem comes up.(Gestational Diabetes which is running rabid in the pregnancy community is the main thing that comes to mind)

I have just spent hours reading all these comments.. anyone that has a serious problem with home birth should read ALL the comments as well. It is pretty clear from reading them that there are positive points and negative points for birthing in BOTH places. Complications arise in BOTH places. There are dangers giving birth in BOTH places. If you choose a home birth ( 1st of all i talking about low risk women here.. high risk does not apply to this article or my comment) you will most likely avoid interventions such as pitocin, forceps, episiotomy, iv etc. etc as well as c section. If you choose hospital birth and a MAJOR complication arises you may have a better chance of your baby surviving. If you choose a home birth you probably have a better chance of avoiding infection in yourself and your child. If you birth in a hospital you may have a better chance of having a quick heart surgery for your baby if one is needed. If you birth in a hospital you may have great care. If you birth at home you will most likely have the wonderful care you are searching for. You may feel more safe being near surgeons, you may feel more safe being in the privacy of your home with people you trust. Your baby may die at home. Your baby may die in a hospital. Your baby may suffer permanent brain and or spinal injury at a hospital due to misuse of forceps. Your baby may die at home if there is a cord prolaspe that needs immediate c section and your more than 30 minutes from a hospital. The list goes on and on and on and on. THERE ARE DANGERS IN BOTH PLACES PEOPLE!! The choice is up to the woman and her husband. PERIOD. DO not judge anyone for a choice they have made when they have the best interest of their child a heart. I am so frustrated by women not supporting one another. Come on! We are not in high school anymore.. this sh*t does not need to continue.. Don't criticize a woman and tell her she is a bad mother for making a decision that took months and lots of research to come to. Both choices can be great choices and both choices can turn out with bad outcomes. END OF DISCUSSION.

While I was pregnant, I wanted to deliver at home, but as my husband's other 2 children had been big babies, we decided it'd be better to deliver in the hospitial just in case. I ended up going 2 1/2 weeks PAST my due date and being induced anyway. The hospitial staff was very good-we took the tour first and met the staff and saw the rooms,ect and gave them my birth plans as well(no meds). So when I checked in, they had all the paperwork finished, knew my preferances and made sure I was comfortable the whole time. I ended up getting an epi, but when my water broke my son fell onto the umbilical cord and his heart rate dropped below 50(it had been 145). All the nurses sprung into action and were calmly explaining everything they were doing while giving me instructions(breath deeply frrom oxygen mask,ect.) After 10 minutes they were able to get his heart rate back to 100 and my Dr still gave me the option to try and deliver naturally, but made sure I knew that his advice was to c section, which is what we chose. Had I tried to deliver(just because I wanted to avoid being cut open) more then likely my son would have died or had health issues from being without oxygen. Even knowing that, my Dr. STILL gave me the option, but made sure I knew the risks first. In the end I'm glad I went with the C section and I ahve a very healthy little man to show for it. Everyone's choice is their own but home birth isn't dangerous because of what IS going to happn, but what COULD happen and I'm glad I opted for medical intervention

"Most likely would have died or had health issues from being without oxygen?" How do you know that though? It is possible your baby would have been fine and it is possible your baby might not have been fine. You have no way of knowing that now. However, now and for the rest of your life, every time you meet a pregnant woman and they ask your story you may bring up this "fact" that your baby would've have died if not in the hospital and it simply is not true. THIS is how fear gets spread and this is how fear of home births especially get spread. You will never know if the pitocin you were given and epi were the additionally reasons for your baby's drop in heartbeat. Or possibly being attatched to a fetal monitor and not being able to move.. that is a very common cause for a baby's heart beat to drop. Some walking around and change of positions could have fixed that in less than a minute.. not ten. If you had chosen a home birth your midwife might have suggested you go to the hospital but before doing so would have recommended natural ways to induce labor. Nipple stimulation( by your husband) castor oil, etc. I just feel that people need to be more open minded about things. They are not so black and white all the time.

Women should give birth where they feel safe, comfortable, and supported by loved ones and experienced professionals. I would be willing to bet that, if this study controlled for all three of those factors, it would show little or no difference in outcomes at home and in the hospital.

If it did continue to show higher incidence of neonatal death at home due to response to respiratory distress, is the solution to tell women they are endangering their babies by having women at home? No, the solution is to caution women to check their birth attendant's credentials and training in responding to respiratory distress. The solution is to stop marginalizing midwives and home births, so that these professionals can have full access to such training and resources. The solution is to open up hospitals and birthing centers for professional and nurse midwives to practice alongside doctors, so that women can have a full array of choices in terms of selecting where they give birth and who attends them.

There is no reason for midwives and doctors to be at war with each other, other than money. And, in my experience, doctors aren't opposed to midwives because they fear losing business to them. They are opposed to midwives because they fear being held liable for midwives' mistakes. This can easily be addressed through legislation, if we could just stop the posturing and bad faith misinterpretation of evidence, like in this article (and home birth proponents are guilty of the same thing).

I'm not saying it's a guarantee that my son WOULD have been injured if I had tried to deliver him vaginally-But I'm not about to take that risk to find out. As for the epi or plitocin having an effect on his heart rate, I'll give the benefit that it COULD have but I find it odd that his heartrate was stabe and strong UNTIL my water broke. As for moving, he had been moving all morning without a problem(WITH a fetal monitor) and the first thing the medical staff did was have me change positions, to no avail. I had no intentions of carrying him as long as I did-we DID try nipple stimulation and walking and nearly everything to bring the labor on naturally(Castor oil can harm baby so again, wasn't doing that), and after that long of a time, it still didn't come on it's own. So for me, being induced WAS the best choice. I'm not saying women shouldn't have home births-I'm pointing out that I had a very easy pregnancy with no forseen complications to think of, and ENDED UP having some and was very glad I was in a hospitial whare they could be dealt with before it did harm my son. That's not trying to scare other women-that's pointing out the ovbious that if something serious does occur, even great midwives aren't equipt to deal with everything and personally I'd rather give my son the best chances rather then be comfortable at home.

It sounds like you made the best choice for you, and it's no one's place to second-guess your decisions. Especially since the ultimate outcome was a healthy baby with a loving mom to raise him. Similarly, people shouldn't second-guess mothers who decide to give birth at home with a trained professional attendant. Bad things can happen at home or in the hospital. Even professionals can make mistakes, or poor decisions. Even the most detailed birth plan can go awry. But these are rare outcomes in any location. There are precautions that can and generally are taken at home to allow access to medical care when it's needed. It is EXTREMELY rare that, in a normal, low-risk pregnancy, the situation crashes so quickly that there isn't time to transport to the hospital, and in those cases being in the hospital usually doesn't make any difference. In virtually all cases, there are warning signs that a problem is brewing, and midwives are trained to recognize those signs, and generally conscious enough of their tenuous legality to practice that they transport at the first hint of those signs. Fetal heart tones that plummet during or between contractions, those are classic signs of a medical emergency that warrants immediate transport to the hospital. Most midwives have policies against attending births greater than a certain distance to an emergency room, or in other conditions that would prevent transport in an emergency. My midwives at my first birth recommended that I transport after 20 hours of labor simply because I was exhausted, even though I wasn't having any other problems. I'm glad I transported, got an epidural, and took a nap. I'm also glad I attempted the home birth and had those 20 hours at home, and that I had the relationship I did with my midwives.

For me, my home birth was more expensive then my hospital birth because the insurance didn't cover as much. It's the educated people who choose home birth with the assistance of a licensed midwife, not the poor and uneducated.

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